Influence of Mirror Therapy Combined with Occupational Therapy on Upper Limb Motor Function and ADL in Hemiplegia after Stroke
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摘要:
目的 观察镜像疗法联合作业治疗对脑卒中患者上肢运动功能和日常生活活动能力的影响。 方法 将40例脑卒中后上肢功能障碍的患者随机分为镜像组和对照组，每组20例。对照组接受作业治疗，镜像组在作业治疗的基础上接受健侧上肢的镜像治疗。于治疗前、治疗2周、治疗4周后采用Fugl-Meyer 评定量表上肢部分（FMA-UE）、运动功能状态量表（MSS）、Brunnstrom分期量表、改良Ashworth痉挛量表及改良Barthel指数量表（MBI）分别对上肢运动功能和日常生活活动能力进行评定。 结果 随着治疗时间的延长，镜像组与对照组的FMA-UE、MSS、Brunnstrom评分、MBI均显著提高，且镜像组患者的以上评分明显优于治疗组，具有统计学差异（P < 0.05）；镜像组和对照组组内的改良Ashworth评分差异无统计学意义（P > 0.05），2组间改良Ashworth评分差异有统计学意义（P < 0.05）。 结论 镜像疗法联合作业治疗能有效改善脑卒中患者上肢运动功能和日常生活活动能力，镜像疗法可作为脑卒中后上肢运动功能康复的一种辅助治疗手段。 Abstract:Objective To observe the influence of mirror therapy combined with occupational therapy on upper limb motor function and ADL in hemiplegia after stroke. Methods Totally 72 patients with hemiplegia after stroke were randomly assigned to the mirror therapy group and the control group, with 36 cases in each group. Both groups accepted occupational therapy. Additionally, the mirror therapy group accepted mirror therapy to train the non-paretic upper limb. The motor function of upper limb and activities of daily living were evaluated by FMA-UE, MSS, Brunnstrom Stage, Modified Ashworth and MBI at baseline, after 2-weeks and 4-weeks training. Results Before training, there were no significant difference between groups in all indexes mentioned above （P > 0.05）. FMA-UE and MBI scores of the upper limb in the mirror therapy group were improved at 2 week and 4 weeks after treatment compared with that of pre-treatment （P < 0.05）; MSS score and Brunnstrom score of mirror therapy group were significantly improved at 4 weeks after treatment compared with that of pre-treatment （P < 0.05） ; After treatment, all indexes mentioned above in the control group had no significant difference compared with pre-treatment （P > 0.05）; Compared with the control group at the same period, the FMA-UE 、MSS and MBI scores of the mirror therapy group at 4 weeks of treatment was higher than that of the control group （P < 0.05）. Conclusion Mirror therapy combined with occupational therapy is helpful for the recovery of upper limb motor function and ADL of hemiplegia patients after stroke, and can be used as an adjuvant treatment for motor function of upper limb after stroke. -
Key words:
- Stroke /
- Mirror therapy /
- Upper limb /
- Motor function /
- Activities of daily living
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表 1 2组患者一般资料比较（n = 20，
$\bar x \pm s $ ）Table 1. Comparison of general data between groups （n = 20，
$\bar x \pm s $ ）组别 镜像组 对照组 t P 年龄（岁） 63.00 ± 13.83 59.10 ± 9.89 1.026 0.312 病程（d） 43.30 ± 28.71 61.20 ± 45.68 −1.484 0.146 
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表 2 2组治疗前、中、后FMA-UE评分比较（
$\bar x \pm s $ ）Table 2. Comparision of FMA-UE scores before, during and after treatment between groups （
$\bar x \pm s $ ）组别 治疗前 治疗2周 治疗4周 对照组 18.45 ± 15.34 20.60 ± 16.09* 23.65 ± 15.83*△ 镜像组 14.45 ± 12.95 25.30 ± 14.46 37.85 ± 19.27 与治疗前比较，*P < 0.05；与对照组比较，△P < 0.05。
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表 3 2组治疗前、中、后MSS评分比较（
$\bar x \pm s $ ）Table 3. Comparision of MSS scores before, during and after treatment between groups （
$\bar x \pm s $ ）组别 治疗前 治疗2周 治疗4周 对照组 15.04 ± 15.84 16.96 ± 15.67 19.33 ± 15.58* 镜像组 14.28 ± 14.79 25.94 ± 18.07 37.15 ± 22.56 与治疗前比较，*P < 0.05。
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表 4 2组治疗前、中、后Brunnstrom上肢评分比较（
$\bar x \pm s $ ）Table 4. Comparision of Brunnstrom scores of upper limbs before, during and after treatment between groups （
$\bar x \pm s $ ）组别 治疗前 治疗2周 治疗4周 对照组 2.25 ± 1.41 2.80 ± 1.28 3.05 ± 1.28 镜像组 2.40 ± 1.14 2.90 ± 1.12 3.45 ± 1.10* 与治疗前比较，*P < 0.05。
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表 5 2组治疗前、中、后Brunnstrom手评分比较（
$\bar x \pm s $ ）Table 5. Comparision of Brunnstrom scores of hands before, during and after treatment between groups （
$\bar x \pm s $ ）组别 治疗前 治疗2周 治疗4周 对照组 2.50 ± 1.54 2.95 ± 1.57 3.15 ± 1.57 镜像组 2.20 ± 1.40 2.95 ± 1.36 3.40 ± 0.99* 与对照组比较，*P < 0.05。
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表 6 2组治疗前、中、后改良Ashworth评分比较（
$\bar x \pm s $ ）Table 6. Comparision of modified Ashworth scores before, during and after treatment between groups （
$\bar x \pm s $ ）组别 治疗前 治疗2周 治疗4周 对照组 0.95 ± 0.54 0.90 ± 0.50 0.90 ± 0.50 镜像组 0.75 ± 0.60 0.75 ± 0.53 0.85 ± 0.46 *P < 0.05。
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表 7 2组治疗前、中、后改良Barthel指数评分比较（
$\bar x \pm s $ ）Table 7. Comparision of MBI before, during and after treatment between groups （
$\bar x \pm s $ ）组别 治疗前 治疗2周 治疗4周 对照组 47.00 ± 21.67 49.50 ± 20.38 54.25 ± 21.54 镜像组 43.25 ± 15.75 55.50 ± 15.12* 67.25 ± 12.62*△ 与治疗前比较，*P < 0.05；与对照组比较，△P < 0.05。
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